Chief executives and boards who run hospitals, primary care trusts and strategic
health authorities have been told to urgently maximise the number of workers
having the jab. Leading DH figures including Sir Liam Donaldson, the chief
medical officer, have written to them six times in the last five weeks stressing
the need for action before the second wave of the pandemic causes major
problems.

Ian Dalton, the NHS's national director of flu resilience, last week warned that
vaccination of nurses, doctors and other frontline staff was "absolutely
critical" and that widespread take-up of the jabs "will help us to save lives".

The DH's letters stress that patients' health could be put at risk and the NHS
left seriously short-staffed through virus-related absenteeism if senior
managers do not overcome "perceived obstacles" to the vaccination of workers.
Swine flu's threat is so great that the NHS must avoid only small numbers of
personnel getting immunised, as usually happens with seasonal flu every winter,
the letters add.

They stress that vulnerable patients could be endangered if staff decide not to
heed repeated urgings from Donaldson and other senior figures to have the
vaccine. There are growing signs that large numbers of workers will shun the
jabs because they see them as unnecessary and potentially unsafe.

Dalton wrote to the chief executives of local NHS organisations in England on 10
September telling them: "We all know that uptake of the seasonal flu vaccine
among NHS staff is traditionally low. It is an NHS board responsibility that we
do not find ourselves in this position with the swine flu vaccine."

But hospital chief executives have told the Guardian that they expect as few as
10%-20% of their staff to get vaccinated and cannot fulfil the DH's demands
because the jabs, which are due to begin within days, are entirely voluntary.

One chief executive of a busy urban hospital in one of the swine flu "hotspots"
said: "At the moment in my hospital if nothing changes then it could be that
10%-20% of staff have the swine flu jab … Staff could have the virus and pass it
on to patients, a proportion of whom will die, albeit a very small proportion."

He added: "The other consequence is that if loads of staff go off with swine flu
that will leave us short-staffed, which is dangerous to patients. That's a
bigger danger than transmission."

Another hospital chief executive said: "Ideally it should be 100% of frontline
staff having the swine flu vaccine. But it obviously isn't going to be. I hope
we'll get at least the 50% we usually get for seasonal flu. This is important
because although this strain of swine flu is mild in most people, if it's
contracted by someone with an underlying health condition that can be serious."

One medical director at another hospital added: "The word on the street in NHS
staff circles is that the vaccine is no good and you shouldn't bother with it.
Nurses in particular worry that there may be side-effects, that corners have
been cut in producing the vaccine and that the generally mild nature of the
virus means they don't need to take it. As few as 10%-15% of doctors may have it
because we doctors believe ourselves to be above such trivial things as
infections."

A poll by Nursing Times magazine last week showed that the proportion of nurses
who do not intend to get vaccinated has risen from 31% in August to 47%, while
those who definitely will has fallen from 35% to 23%.

Dame Christine Beasley, the chief nursing officer for England, responded by
stressing that the vaccine is "as safe as a vaccine can be" and adding: "Nothing
in life is risk-free. I can well understand people being worried. I can well
understand people thinking it's only a mild illness and why should I bother? I
do understand all that, I think you wouldn't be human if you didn't think that."
Beasley wants directors of nursing to act as role models to allay concerns among
frontline nurses.

Hospital chief executives say privately that Donaldson's repeated reminders of
the mild nature of swine flu's effects in those who contract it, and recent
claim that the UK is "tantalisingly close" to beating the virus, may be leading
staff to believe that vaccination is not important.

The health department said: "Frontline healthcare workers will be absolutely
crucial in the height of a pandemic – without them, patient care will suffer,
and the NHS will be stretched. Getting the swine flu vaccine will protect them
and their patients."

It added: "All NHS organisations will be working hard to ensure that all
eligible staff have the choice to protect themselves and their patients from
swine flu by having the vaccine."